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Prevalence, predictors, and prognostic implications of PR interval prolongation in patients with heart failure

Nikolaidou, Theodora; Pellicori, Pierpaolo; Zhang, Jufen; Kazmi, Syed; Goode, Kevin M.; Cleland, John G.; Clark, Andrew L.


Theodora Nikolaidou

Pierpaolo Pellicori

Jufen Zhang

Syed Kazmi

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Dr Kevin Goode
Research Systems Project Manager / Business Analyst

John G. Cleland

Andrew L. Clark


© 2017 The Author(s) Aims: To determine the prevalence, incidence, predictors, and prognostic implications of PR interval prolongation in patients referred with suspected heart failure. Methods and results: Consecutive patients referred with suspected heart failure were prospectively enrolled. After excluding patients with implantable cardiac devices and atrial fibrillation, 1420 patients with heart failure and reduced ejection fraction (HeFREF) [age: median 71 (interquartile range IQR 63–78) years; men: 71%; NT-ProBNP: 1319 (583–3378) ng/L], 1094 with heart failure and normal ejection fraction (HeFNEF) [age: 76 (70–82) years; men: 47%; NT-ProBNP: 547 (321–1171) ng/L] , and 1150 without heart failure [age: 68 (60–75) years; men: 51%; NT-ProBNP: 86 (46–140) ng/L] were included. The prevalence of first-degree heart block [heart rate corrected PR interval (PRc) > 200 ms] was higher in patients with heart failure (21% HeFREF, 20% HeFNEF, 9% without heart failure). In patients with HeFREF or HeFNEF, longer baseline PRc was associated with greater age, male sex, and longer QRS duration, and, in those with HeFREF, treatment with amiodarone or digoxin. Patients with heart failure in the longest PRc quartile had worse survival compared to shorter PRc quartiles, but PRc was not independently associated with survival in multivariable analysis. For patients without heart failure, shorter baseline PRc was independently associated with worse survival. Conclusion: PRc prolongation is common in patients with HeFREF or HeFNEF and associated with worse survival, although not an independent predictor of outcome. The results of clinical trials investigating the therapeutic potential of shortening the PR interval by pacing are awaited.

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Nikolaidou, T., Pellicori, P., Zhang, J., Kazmi, S., Goode, K. M., Cleland, J. G., & Clark, A. L. (2018). Prevalence, predictors, and prognostic implications of PR interval prolongation in patients with heart failure. Clinical Research in Cardiology, 107(2), 108-119.

Journal Article Type Article
Acceptance Date Sep 13, 2017
Online Publication Date Sep 15, 2017
Publication Date 2018-02
Deposit Date Oct 13, 2017
Publicly Available Date Jan 15, 2020
Journal Clinical research in cardiology
Print ISSN 1861-0684
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 107
Issue 2
Pages 108-119
Keywords First-degree heart block, Heart failure, PR interval
Public URL
Publisher URL
Additional Information Copy of article first published in: Clinical research in cardiology, 2017.
Contract Date Oct 13, 2017


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